<!DOCTYPE html>
<html lang="en" xmlns:th="http://www.thymeleaf.org">
<head>
    <meta charset="utf-8"/>
    <meta name="viewport" content="width=device-width, initial-scale=1.0"/>

    <title>代付表单</title>
    <meta name="keywords" content=""/>
    <meta name="description" content=""/>

    <link rel="shortcut icon" href="favicon.ico"/>
    <link href="../css/layui.css" rel="stylesheet" th:href="@{/css/layui.css}"/>

</head>
<body class="full-body">
<div class="form-content">
    <!-- 代付界面 -->
    <div id="paymentDiv" class="layer_self_wrap" style="margin:30px auto; width:500px; height:500px;">
        <form id="dfForm" class="layui-form layui-form-pane">

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>代付类型</label>
                <div class="layui-input-block">
                    <select name="service" lay-verify="required" lay-search="">
                        <option  value="">请选择</option>
                        <option  th:each="list:${tradeList}" th:value="${list.tradeType}" th:text="${list.tradeType}" ></option>
                    </select>
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>账户名称</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="account_name" placeholder="请输入账户名称" class="layui-input" name="account_name" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>卡号</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="bank_card" placeholder="请输入卡号" class="layui-input" name="bank_card"/>
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>代付金额</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required|validateMoney" placeholder="请输入代付金额(元)" id="trans_money" class="layui-input" name="trans_money"/>

                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>银行名称</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="bank_name" placeholder="请输入银行名称"  class="layui-input" name="bank_name" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>支行名称</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="bankBranchname" placeholder="请输入支行名称" name="bankBranchname" class="layui-input" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>银行简称</label>
                <div class="layui-input-block bankSelect" >
                    <select id="agentBankSelect" name="bankCode" lay-verify="required" lay-search="">
                        <option value="">请选择</option>
                        <option value="BOC">中国银行</option>
                        <option value="ICBC">中国工商银行</option>
                        <option value="ABC">中国农业银行</option>
                        <option value="CCB">中国建设银行</option>
                        <option value="PSBC">中国邮政储蓄银行</option>
                        <option value="CEB">中国光大银行</option>
                        <option value="CMBC">中国民生银行</option>
                        <option value="BJBANK">北京银行</option>
                        <option value="SHBANK">上海银行</option>
                        <option value="CMB">招商银行</option>
                        <option value="SPABANK">平安银行</option>
                    </select>
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>联行号</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="bank_linked" placeholder="请输入银行联行号"  class="layui-input" name="bank_linked" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label">开户省份</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="bankProvince" placeholder="请输入省份" name="bankProvince" class="layui-input"
                    value="" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label">开户城市</label>
                <div class="layui-input-block">
                    <input type="text" lay-verify="required" id="bankCity" placeholder="请输入省份" name="bankCity" class="layui-input"
                    value="" />
                </div>
            </div>

            <div class="layui-form-item">
                <div class="layui-inline">
                    <label class="layui-form-label"><font color="red" style="margin-right: 2px">*</font>短信验证码</label>
                    <div class="layui-input-inline">
                        <input type="text" id="verifyCode" lay-verify="required" placeholder="请输入短信验证码" name="verifyCode" class="layui-input" />
                    </div>
                </div>
                <div class="layui-inline">
                    <input type="button" class="layui-btn generate_code" value="获取短信验证码" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label">手机号码</label>
                <div class="layui-input-block">
                    <input type="tel" id="phoneNo" placeholder="请输入手机号码" name="phoneNo" class="layui-input" maxlength="11" />
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label">身份证号码</label>
                <div class="layui-input-block">
                    <input type="text" id="idcard" placeholder="请输入身份证号码" name="idcard" class="layui-input" />
                </div>
            </div>

            <div class="layui-form-item">
                <div class="layui-input-block" style="float: center">
                    <button class="layui-btn"  lay-submit="" lay-filter="addAgentPaymentSubmit">提交</button>
                    <button type="reset" class="layui-btn layui-btn-primary">重置</button>
                </div>
            </div>
        </form>
    </div>
</div>


<!-- 全局js -->
<div th:include="common/common_js :: onloadjs"></div>
<!-- 自定义js -->
<script th:src="@{/js/agentpayment.js}"></script>

</body>
</html>